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MORAN v. RUSH PRUDENTIAL HMO, INC.

No. 99-2574.

230 F.3d 959 (2000)

Debra C. MORAN, Plaintiff-Appellant, and State of Illinois, Intervenor-Appellant, v. RUSH PRUDENTIAL HMO, INCORPORATED, Defendant-Appellee.

United States Court of Appeals, Seventh Circuit.

Decided October 19, 2000.

Attorney(s) appearing for the Case

Daniel P. Albers (argued), Barnes & Thornburg, Chicago, IL, for plaintiff-appellant.

Melinda Sue Kollross (argued), Clausen Miller, Chicago, IL, for defendant-appellee.

John P. Schmidt (argued), Office of the Attorney General, Civil Appeals Division, for intervenor-appellant.

Wayne R. Berry, Department of Labor, Office of the Solicitor, Washington, DC, for amicus curiae U.S. Department of Labor, Secretary.

Leonard A. Nelson, American Medical Association, Office of the General Counsel, Chicago, IL, for amicus curiae American Medical Association, Illinois State Medical Society, and American College of Legal Medicine.

David E. Manoogian, Epstein, Becker & Green, Washington, DC, for amicus curiae Illinois State Chamber of Commerce and Employment Law Council of Illinois.

Before FLAUM, Chief Judge, and RIPPLE and WILLIAMS, Circuit Judges.

RIPPLE, Circuit Judge.

Section 4-10 of Illinois' Health Maintenance Organization Act ("the HMO Act"), 215 ILL. COMP. STAT. ANN. 125/1-1 et seq., requires HMOs to submit to an independent physician review when there is a disagreement over whether a course of treatment is medically necessary between a patient's primary care physician and the HMO. In the event that the independent reviewer determines that the treatment is necessary, the HMO is required under § 4...

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